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tv   [untitled]    July 20, 2013 10:00pm-10:31pm PDT

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move away and we can look at on the one hand, other plans. so i think we have optioned too. but at any event, you know, just on this i've covered enough on the implementations. we do need to remember, if we doing go to a two plan model we have two self-insured plans we can utilize the risks. and there's a big difference between taking risks. the pricing going forward with kaiser could be very much impacted by kaiser. the competition is the best
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control we've got over the providers and that has some impact. if we only had blue shield and the city plan we couldn't hold the line on cost increases either. so the private hospitals could raise their prices and even though we're self-insured we're blue shield the city is paying those claims. so if you get a situation where the competition didn't feel the competition of kaiser it could chan changely. and the budget would have to be recalculated we have to post for the health care benefits and that would have to be recast because it would be a ripple
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effect. so that's on health care implementations the 46 thousand members have to find new provided as the co- pays would go up. the member contributions in their paychecks could go up if we go going down that road. right now for the e plus one or two or more you can see on this chart the difference is like double and triple on a monthly basis so how that would play out we'll have to see. and finally there's legal obligations if we don't make our january one or october deadline. there could be legal obligations for missingor deadlines but there could be members who or so
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upset people can leave kaiser and there could be lawsuits. this is unbalanced and probably an unpractical course of action. so i'm not - if you have any more questions i'll be happy to try to answer them >> staff any questions at this point. >> we do have some representatives from kaiser they have some materials to present if that's all right. >> absolutely.
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>> you guys have copies correct. >> great. good morning. i have our senior department peter. and there's quite a few slides and my intention so to go through the first 10 but certainly able to answer questions. it's a compliment but just very quickly on the agenda we're going to review the market trends for 2015 around the wellness a great question has been raised if kaiser choose not
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to be renewed and the transparency. on slide 3 a very quickly overview on the calibration. we have a total increase in the green bar and it's broken down into blue as the kaiser portion of the calculation that's been presented for the total of 58.01. when you add them together you'll see the percent that was referenced and on slide four we thought what would be helpful is do a fairly high-level of the process. greg shared with you the packet of information and the details behind it. so when we develop the utilization the rate for the
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following year the core component is the claims utilization the actual confidence in terms of volume that's experienced by your members. what you'll see here between 2011 and 2012 there's american people increase for a total 5 point plus increase. just for a comparison for the books in kaiser there's a about 3 million members our comparative is slightly below but in alignment. this is generally at the lottery level how do we take that information. there's a process with lots of
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factors but we take the information from 2012 and that includes the inpashtd and out partiality and surgery and mental health substance because of these and ma ternlt lab and so forth. we look at the gender and age of those services. as an overall in a couple of key areas that are that come out is maternity for example, there are more delivers and the stays are a little bit longer which is a more intense procedure. oftentimes this shows lower invests but if you have a
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furrier number come in but stay long-range you'll see the prices go up. so we take all the data we capture throughout 2012 and use it for the projection of 2014. what is it i expect to happen and what's the cost to cover those services in 2014. we apply our administrative costs charge which is our margin and unnecessary thorough 2014 that build up to 320.48 and then there's the additional tax to get to the total. on slide of one of the other questions that was raised or questions this was asked is to look at this from a historical
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prospective. this is one year the blue bar represents the renewal costs from 2006 until this year and this is a trend of information over the same period of time. we remember as far back as we could and summarized the two afternoons. and the market has been 10.2 so close to 4 percent difference. if you look at the last 6 years we've w50i8gd that gap. our average has been slightly less than 5 percent for the city. slide 7. so to summarize the 2014 level
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greg spoke to that frail well, we've projected the information forward to he'd the claims experience in the 2014 for the employees and the retirees and their families. as greg stated we use the methodology for the large group of employers. so the commitment for 2014 a great question was raised. we talked about beginning immediately so what does that mean? working towards mutually clear objectives about what we're trying to do and that's gone the conversations. the analysis of data. there are models that in fact do
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the approach and you have that with our other two plans. we've gone those conversations and the goal is to work towards the successful renewal. regardless of what methodology you use it the claims information. we won't have met 2013 information is it can't happen until the information has actually happened. the information that we do the engagement is the underlying data. we talked about the most important piece and donates the claims information. we looked at that kwaerl and annually and those conversations will happen >> supervisor mar. >> to supervisors avalos
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question how early would we start. you're saying immediately. what would have been the normal time now that you've started awe that is >> we'll typically have in a normal somewhere with most employers we've got a quarterly data most often on their desire we'll start around february or march talking about benefit changes is there go anything they want to see different. we add if our trend information at the beginning of april and that's the normal timeline >> i'm very pleased that the sharing of information on a monthly basis and really looking at the o ms and icm the acronyms the data m that was shared with
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the department. >> one more comment you all have to share a budget. we don't know what the budget is to run our entire program. we have estimated that but that budget doesn't get set and based on that budget and estimating how many members are that are going to come through the program set the increases for next year. this is an internal budget we have to do internally >> thank you. okay. so on to slide 9. so a little bit more detail on the commitments we've made pa to h ss. again, this is a level slightly below the documents that we've provided in hardcopy.
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it's sent over to the 0 data depository and that's another way to evaluate that data on a regularly basis. in addition to the indicators on the process twice a year. we'll be working towards looking at our current performance guarantees and focusing on any which one conditions from a budget prospective human resources how low are remeeting and stooed the metrics for the members health and for the cost control. and the last component is around wellness so working on not just a year by year basis but by a
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week by week method and the flu season we look at that a timeframe. we're looking at a research project around evaluating the true effectiveness and highway we know learn from the process and apply it into future engagements. and, of course, those involve lots of details and coordination >> i really am appreciative of the monthly reports and the discussions on the relevance of the material. i know we have additional nurses
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who have helped with flu shots and the research study as well i hope we can get more details on that and even in quantitying how much that is for the city. i guess i was saying i'm appreciative to the work behind the scenes with our staff and i guess what's still in my head you've given us the long-range of the plan for san francisco. i do so the profit margin and again, i'm going to slide 16 from the may meeting where it shows in the past 5 years the profit margin just going up significantly especially last
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year and this year. and i think the concern as sum are saying kaiser is gouging other jurisdictions and that $15 million and i know the ac a-1.17 percent by roughly the leveling million dollars is a profit margin and i'm not sure how much kaiser is taking in that profit margin but could you address that >> yeah. i think we've been very public around the margin that we budget for our entire program is between 4 and 5 percent. we've said this for four years publicly so when with he do your overall budget setting we're bukt to get that four and a half percent and that's used for
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additional technology. so when we price our 8 thousand or so large group consumers we have throughout california we set a price that it come in a way we budgeted it should be 5 percent. but what happens is we don't get every thing right on what their costs and utilization are going to be. but the law of large numbers we will not get every single group right but when you add them all up it will come out to 4 percent. we can argue how much we made on your individual group over the last several years we don't believe it's as much as state but we did make a margin on the
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group and it's also around four and a half 5 percent. so we'll do everything we can to be transparent and with the possible risk sharing we'll be able to both share in gains and losses with you and have more transparency there. i hope that helps >> thank you so slide 10 the last two. so there's some questions raised and greg had outlined one the questions but i wanted to convey based on the information we heard last week and what we shared was if the contract isn't renewed we need to find a way for reimbursement but without a
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contract in place there's no way to be reimbursed for services render then we will need to work diligently to transition those numbers to other care providers. there's legislation and rules around that but we need to engage in this direction. and the last slide is the summary. this is a year around reporting. the left side it the reports. what we add to this is a monthly claims feed that provides f that information to the depository and that's it for our form presentation peter >> i want to make a statement around our tennis how commented we are to you as a client and
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commented to our employees and members in the city and county 70. we've done a lot of great things together in the city and county of san francisco. we've worked with the unions for years and years and years and we take care of a huge amount of your employees ease we want to live up to that and be a good citizen of the city and county of san francisco. at this point our relationship is not where i think every one of us want it to be we can move closer or farther apart. we want to move with the staff forward and make this mutually saefs for you and us. i want to be clear we'll be transparent. we will work hard to provide the
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service and medical care to your employees in the best way we can and in the most affordable way we can. this is our mission this is 1 hundred thousand employees that kaiser lives for to take care of. i want to remember everyone we're the cheap itself carry. we're fully insured which maples we take 1 hundred percent of risk and we think that 4 percent is reasonable given what's going on in the marketplace. we're committed and willing to serve the 45 thousand members and employees. those are our neighbors too. thank you
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>> i really appreciate that statement of continuing the long 60 plus year partnership and really the com i am not around the wellness program is appreciative. i want to talk about the nature of getting more data to have that mature trust and the term is proprietary and we'll not address that >> let me start with you regret the use of that word i wish our organization had not said that. what you have here will describe
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the risk and utilization leads to the cost it leads to. i think the bigger question you want the answer to say one year an off the invest costs $40 and next year it's 42 this year. i can tell you the risk of your group drives the renewal. let's look at the increase. new and more expensive drugs, technology and building facilities for your men's and building hospitals. there's a huge number of things that drive inflation we'd love to sit down and talk about that. and what we're doing to drive
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down those costs. i can let the costs go up. we're actually trying to keep the costs down but in the end you want to know how we're driving the costs down. the information is here but the offer ail inflation is a economic issue it's in every health system in america. it's interesting that the new york times about a month going ago did this study and the costs of medical care goes up. one of the things you're going to get at kaiser wherever
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surgeries got up we're going to have a reasonable costs and we don't add on a huge amount if you or are one carry it costs more or less. we'll love to have a conversation about medical inflation by the answer is not in this book that is around your cost implementation >> colleagues any comments? >> thank you very much for your presentation. before we go to mr. rose report we have some health folks here commissioner scott and lynn as well and other confirmations. is there anyone else here i hope
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i haven't missed anyone. do you want to read a statement i want to recognize you separately >> i'm randy scott the newest commissioner on the board and i do wish to apologize to the department and wanting i'm supposed to be in a meeting in my office at this moment. i appreciate the comments of kaiser. i was one of the two commissioner that voted against the rate renewal for a variety of reasons most of which related to the unanswered questions. however, knowing this this process needed tow moderate i stated on that occasion i felt
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we as a board we are left with no option but to move this forward. i think it will be a horrible distraction to walk into a pictured of urban certainty this fall not having a contract in place. i think it can be avoided by your not regretting that. you mate not want to endorse it but i hope you'll give it the attention for the reasons that were outlined this morning to approve this. i'm not satisfied by the full representation of the kaiser hospital but i hope to be involved very close in the
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processes and i think the board will be likewise. there's things that should be taken beyond the process like transparency. i thought that you have to do more than pass a resolution you need to be advocating at the state level any information that shares those goals. and you need to think partnering with california to see how we can push and require all insures to be where they're at. i think we have an opportunity to move forward aggressively with kaiser and cause them to move out of their comfort zone
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and i've heard their comfort zone. 60 years of relationship should not be where you can predict where you'll be in 5 years. but there's had a mature risk here as well in terms of outlining a position that is based on trust as well as what the data has to say. my hope is we can get at the transparency we want and absolutely need in this day and age. thank you >> thank you commissioner scott. again, if i want to speak i want to make sure i give you the opportunity. and for colleagues and those in the audience as well commissioner scott, thank you for being here i k